Podcast
Questions and Answers
What is the primary sound associated with the closure of the AV valves?
What is the primary sound associated with the closure of the AV valves?
- S3
- S4
- S2
- S1 (correct)
Where is the mitral valve best auscultated?
Where is the mitral valve best auscultated?
- 2nd intercostal space sternal border
- 3rd intercostal space sternal border
- 5th intercostal sternal border
- 5th intercostal midclavicular line (correct)
What does an S3 heart sound signify?
What does an S3 heart sound signify?
- Closure of the semilunar valves
- Incomplete closure of AV valves
- Rapid filling of an overfilled ventricle (correct)
- Atrial contraction
Which position allows the best access for auscultation of the mitral valve?
Which position allows the best access for auscultation of the mitral valve?
During which phase of the cardiac cycle is the S4 sound produced?
During which phase of the cardiac cycle is the S4 sound produced?
Which of the following best describes the sound produced by the closure of the semilunar valves?
Which of the following best describes the sound produced by the closure of the semilunar valves?
What are the high-pitched sounds typically associated with?
What are the high-pitched sounds typically associated with?
What can the presence of a mitral murmur indicate?
What can the presence of a mitral murmur indicate?
What type of heart sound is commonly associated with mitral valve prolapse?
What type of heart sound is commonly associated with mitral valve prolapse?
Which of the following statements accurately describes a pansystolic murmur?
Which of the following statements accurately describes a pansystolic murmur?
What is the timing of a diastolic murmur in relation to S1 and S2?
What is the timing of a diastolic murmur in relation to S1 and S2?
Which characteristic describes a 'crescendo' murmur?
Which characteristic describes a 'crescendo' murmur?
Which type of murmur is caused by mitral stenosis?
Which type of murmur is caused by mitral stenosis?
Which murmur shape is characterized by a sudden drop in volume after it reaches its peak?
Which murmur shape is characterized by a sudden drop in volume after it reaches its peak?
What is a characteristic of a midsystolic ejection murmur?
What is a characteristic of a midsystolic ejection murmur?
What is a common cause of an early systolic click?
What is a common cause of an early systolic click?
Which grade of murmur is described as 'soft and very faint'?
Which grade of murmur is described as 'soft and very faint'?
Which characteristic is typical of a mitral valve prolapse murmur?
Which characteristic is typical of a mitral valve prolapse murmur?
Which of the following correctly describes the timing of a murmur associated with aortic regurgitation?
Which of the following correctly describes the timing of a murmur associated with aortic regurgitation?
What is the grading scale for describing the intensity of murmurs, specifically for a grade 2 murmur?
What is the grading scale for describing the intensity of murmurs, specifically for a grade 2 murmur?
Which feature is often associated with a holosystolic murmur?
Which feature is often associated with a holosystolic murmur?
What distinguishes a crescendo-decrescendo murmur?
What distinguishes a crescendo-decrescendo murmur?
A patient presents with a systolic murmur heard best at the left lower sternal border. Which pathology may be indicated?
A patient presents with a systolic murmur heard best at the left lower sternal border. Which pathology may be indicated?
How is a murmur classified if it is described as 'blowing' in quality?
How is a murmur classified if it is described as 'blowing' in quality?
What murmur characteristic can help indicate the presence of hypertrophic obstructive cardiomyopathy?
What murmur characteristic can help indicate the presence of hypertrophic obstructive cardiomyopathy?
What is the significance of a murmur that is described as persistent throughout systole?
What is the significance of a murmur that is described as persistent throughout systole?
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Study Notes
Auscultation and Heart Sounds
- Resonance over lungs indicates the presence of air; cardiac dullness suggests fluid or solid mass in the heart area.
- Auscultatory Areas (5 regions, "APE To Man"):
- Aortic: 2nd intercostal space at sternal border
- Pulmonic: 2nd intercostal space at sternal border
- Erb's Point: 3rd intercostal space at sternal border
- Tricuspid: 5th intercostal space at sternal border
- Mitral: 5th intercostal space at midclavicular line
- Diaphragm used for high-pitched sounds (S1, S2, most murmurs).
- Bell captures low-pitched sounds (S3, S4, mitral stenosis rumble).
- Patient Positioning:
- Sitting/leaning forward brings the heart closer to the chest wall for better auscultation.
- Supine position facilitates listening to all areas using both diaphragm and bell.
- Left lateral decubitus position allows better access to mitral area for S3, S4, and murmurs.
Normal and Abnormal Heart Sounds
- S1:
- Loudest at apex, coincides with carotid pulse, indicates closure of AV valves.
- S2:
- Louder at base, indicates closure of semilunar valves.
- S3 (Ventricular Gallop):
- Caused by blood flow slamming into an overfilled ventricle during early diastole; early sign of heart failure.
- S4 (Atrial Gallop):
- Caused by blood entering a stiff left ventricle during atrial contraction; indicative of left ventricular hypertrophy.
- Extra Sounds:
- Early systolic click (aortic/pulmonic stenosis), mid-systolic click (mitral regurgitation), and opening snap (mitral stenosis).
- Murmurs:
- Characterized by timing, location, shape, grade, intensity, radiation, and patient position. They suggest turbulent blood flow.
Types of Murmurs
- Systolic Murmurs:
- Midsystolic ejection (aortic and pulmonic stenosis) and pansystolic (mitral/tricuspid regurgitation).
- Diastolic Murmurs:
- Rumbles of AV valve (mitral/tricuspid stenosis) and early diastolic (aortic/pulmonic regurgitation).
Physical Examination
- General Order:
- General appearance, blood pressure, neck vessels, precordium inspection, palpation, auscultation.
- Blood Pressure:
- SBP reflects ventricular contraction; DBP indicates ventricular relaxation.
- Orthostatic Hypotension:
- Defined by a drop in SBP over 20 mmHg or DBP over 10 mmHg within 3 minutes of standing.
- Carotid Arteries:
- Assess one at a time; grade pulse from +1 (weak) to +4 (bounding).
- Jugular Venous Pressure:
- Estimation performed with the patient at a 30-degree angle, measuring vertical height above sternal angle.
Precordium Assessment
- Inspection for Heaves:
- Possible visible pulsations/lifts indicating cardiac issues.
- Palpation for Thrills:
- Felt vibrations indicating loud murmurs, assessed at auscultatory areas.
- Point of Maximal Impulse (PMI):
- Palpation to assess left ventricular health, noting amplitude and duration for indications of overload or hypertrophy.
Structural Valve Abnormalities
- Normal Valve: Allows one-way flow.
- Stenotic Valve: Noctably stiff; impedes blood flow.
- Incompetent Valve: Prolapsed; leads to regurgitation (backflow).
Developmental Considerations
- Fetal/Newborn Heart:
- Ductus venosus shunts blood away from the lungs; acrocyanosis in infants is normal.
Peripheral Vascular Assessment
- Arterial System: High-pressure system; must assess for both normal and abnormal conditions.
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